AMA discourages secret shopper program

Chicago Tribune

Published Monday, June 16, 2008

CHICAGO -- While secret shoppers are commonly used to improve customer service and quality in retail stores, restaurants and hotels, members of the American Medical Association don't want them in doctors' offices.

That was the prevailing opinion of doctors who testified before an AMA panel at Sunday's annual meeting of the group's policy-making House of Delegates in Chicago. Testimony before the panel is the first step in a process that could lead to becoming policy of the AMA, the nation's largest doctor group, representing nearly 250,000 physicians.

The secret shopper concept is not being proposed to evaluate clinical skills but the way medical professionals manage relationships with patients, from the process of making appointments to such things as explanations of billing practices.

As health-care costs rise, health insurance companies, employers and consumers and others who pick up the tab for U.S. medical care are increasingly demanding quality information to ensure they are making informed choices about the kind of care and service they will receive at the doctor's office. And as health plan deductibles become higher, patients are increasingly shopping around.

To accommodate such consumer demands, insurers and hospitals are increasingly becoming open to ratings and other information as a way to become more consumer-friendly. The use of secret shoppers, doctors say, is becoming part of the consumer health information wave with such data eventually fed back to those being rated or to third-parties who build their own databases for consumers.

But AMA members told the panel that they did not trust the secret shopper concept, saying such patients could get in the way of needed medical care for real patients. In addition, doctors say, information gathered could be used to cut payments to doctors or used by trial lawyers as a way to damage physicians in court.

"It is grossly unethical," said Dr. Howard Chodash, an associate professor of gastroenterology at Southern Illinois University Medical School and an AMA delegate representing the Illinois State Medical Society.

Other doctors say they should be able to get enough feedback on how their practice is doing from their own patients.

"We should use real patients as sources of real information we need about quality of care," said Dr. George Anstadt, an AMA delegate from Pittsford, N.Y., who is representing the American College of Occupational and Environmental Medicine. "This goes against the grain of the doctor-patient relationship."

Chodash was among more than a dozen doctors who spoke before the panel, most voicing strong opposition to the use of secret shoppers. The issue is one of many the group will consider as part of its annual meeting held through Wednesday at the Hyatt Regency Chicago. The secret shopper concept could be endorsed, rejected or referred for more study when the 565-member House of Delegates votes on it later this week.

The AMA Council on Ethical and Judicial Affairs, which studied the issue and brought it before delegates this week, has asked the group to endorse such practices.

"It can highlight things that we are not aware of that can benefit our practices," said Dr. Rex Greene, a member of the ethics panel who practices hematology-oncology in Lima, Ohio. "We would like certain parameters where ethically appropriate. This is a practice management tool."

The idea of the secret shopper is to evaluate "most of the steps of the patient experience, from the ease of making an appointment over the phone, to the environment and flow of patients in the waiting room, to the encounter with the physician," the ethics council wrote in a four-page report.

Greene said the idea is not to bring the secret shopper into the exam room to evaluate a doctor's clinical skills. Rather, it should be used to find out, for example, whether the staff was professional, he said.

Greene said some doctors may not have a choice on whether they will one day be evaluated by secret shoppers, especially if they work for a large group practice. He said medical directors of group practices that employ physicians are conducting such evaluations already and the doctors in the practice have no choice but to go along with them.

"We are running a service business and we are not as focused on that as we should be," Greene said in an interview.